| |
8784 Se 165th Mulberry Ln, The Villages, FL 32162-5861 | |
(352) 753-4530 | |
(352) 259-5862 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 8784 Se 165th Mulberry Ln, The Villages, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1669650305 | NPI | - | NPPES |
1219930002 | Other | FL | DME |
K1349 | Other | FL | MEDICARE ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPC2612 (Florida) | Secondary |
207W00000X | Ophthalmology | ME0071525 (Florida) | Secondary |
207W00000X | Ophthalmology | ME89546 (Florida) | Primary |
Mailing Address | Practice Location Address |
---|---|
936 Bichara Blvd, Lady Lake, FL 32159-7714 Ph: (352) 753-9888 | 8784 Se 165th Mulberry Ln, The Villages, FL 32162-5861 Ph: (352) 753-4530 |